Provider Demographics
NPI:1083699359
Name:TOMKIEWICZ, ROBERT P (MD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:P
Last Name:TOMKIEWICZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:7137 MARYLAND AVE
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63130-4417
Mailing Address - Country:US
Mailing Address - Phone:314-721-0675
Mailing Address - Fax:314-721-2830
Practice Address - Street 1:6125 CLAYTON AVE
Practice Address - Street 2:#119
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63139-3265
Practice Address - Country:US
Practice Address - Phone:314-645-8823
Practice Address - Fax:314-645-5018
Is Sole Proprietor?:No
Enumeration Date:2005-12-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MOMO 2003017186207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
H99642Medicare UPIN